Evaluation of Bleeding Self-Assessments By Patients with Immune Thrombocytopenia (ITP): An Agreement Study
Notice bibliographique
Résumé
Introduction. Immune thrombocytopenia (ITP) is an autoimmune condition that causes an increase in the risk of bleeding. Bleeding is a patient-important outcome; however, timely and complete assessments of bleeding are time- and labour-intensive. ITP bleeding measurements may be simplified with patient self-assessments. We designed this study to compare the agreement of bleeding assessments done by ITP patients and by trained research staff. Methods. All patients were identified from the McMaster ITP Registry, a longitudinal registry study of consecutive adult patients with thrombocytopenia followed at the McMaster University Medical Centre, a tertiary referral clinic. A modified version of the ITP Bleeding Scale was used for all bleeding assessments, which captured the patients' worst bleeding event at each of 9 anatomical sites - skin, mouth, epistaxis, gastrointestinal, genitourinary, gynecological, pulmonary, ocular or intracranial - graded from 0 (no bleeding) to 2 (severe bleeding) from the time of the last assessment (typically 6 months prior). Patients were provided with instructions on how to use the scale and asked to complete bleeding self-assessments using an online tool. Once the patients completed their self-assessments, a trained research staff member contacted the patient to repeat the bleeding assessment by telephone. Chance-corrected interrater agreement was determined using the kappa statistic for 2-way agreement (Grade 2 vs. Grade 0 or 1 bleeding) and for 3-way agreement (Grade 0 vs. Grade 1 vs. Grade 2). Chance-independent 2-way agreement was also measured using the phi statistic. The primary analysis was the 2-way kappa, since the detection of Grade 2 bleeds is clinically important. Results. We enrolled 108 consecutive patients with ITP from the McMaster ITP Registry who had duplicate bleeding assessments done. The median time between assessments was 3 days (IQR, 2-5). Median age of patients in the study was 53 years (IQR, 38-64), 64% were female. The worst bleeding events, as determined by research staff, were Grade 0 (n=22, 20.4%), Grade 1 (n=34, 31.5%) or Grade 2 (n=52, 48.1%). There was perfect agreement for bleeding assessments at all anatomical sites for 44 patients (40.7%). There were no intracranial hemorrhages and no Grade 2 genitourinary or pulmonary bleeds were reported. Chance-corrected 2-way agreement was excellent for gynecological (k=0.86, 95% CI 0.71-1.02), gastrointestinal (k=1), genitourinary (k=1), pulmonary (k=1) and intracranial (k=1) bleeds ( Table). Agreement was good for skin (k=0.68, 95% CI, 0.54-0.82), oral (k=0.76, 95% CI, 0.53-0.98) and ocular (k=0.66, 95% CI, 0.04-1.28) bleeds, and moderate for epistaxis (k=0.58, 95% CI, 0.21-0.95). Results of chance-independent agreement and 3-way agreement were similar. Conclusions. Bleeding self-assessments by ITP patients yielded comparable results to trained research staff. Agreement for skin and epistaxis was lower than for other sites, suggesting that additional instructions or prompts may be needed for these categories. Bleeding self-assessments could simplify data collection in research and in clinical practice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,035 | 0,088 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».